Commentary: Expanded police powers don’t have to mean ‘three steps forward, two steps back’ for mental health in Singapore
There are concerns that a new proposed law might add to the stigma around mental health and deter people from seeking help. But it also provides an opportunity to advance community mental health, says psychiatrist Dr Jared Ng.
File photo of people crossing the street at South Bridge Road in Singapore. (Photo: CNA/Syamil Sapari)
This audio is generated by an AI tool.
SINGAPORE: In my 17 years as a mental health professional with experience in community psychiatry and emergency and crisis care, I’ve worked alongside dedicated colleagues and law enforcement counterparts to respond to mental health crises in the community. These are often high-risk and unpredictable, making crisis response complex.
Too often, well-intentioned interventions can escalate unnecessarily and do more harm than good. Yet, there have also been instances where families and psychiatrists strongly felt there was a likely threat, yet police officers were unable to act due to prevailing legislation.
Earlier in March, the Ministry of Home Affairs proposed a law that would give police officers more powers to apprehend “mentally disordered” people who pose a safety risk to themselves or others.
There are concerns about whether the new Law Enforcement and Other Matters Bill might inadvertently add to the stigma around mental health, by reinforcing stereotypes that those who have mental disorders are dangerous or deterring people from seeking help for fear of having a “record”.
Despite its potential challenges, I choose to focus on the opportunities it creates for collaboration and progress in mental health crisis response.
SUPPORTING A COMMUNITY MENTAL HEALTH APPROACH
The intent is admirable - and necessary. Singapore, like many countries, has moved toward a community mental health approach and away from institutionalised psychiatric care.
Consider this scenario: A young, visibly disoriented person is shouting angrily at an invisible threat, pacing outside a crowded coffeeshop. They pose no immediate physical threat but onlookers are frightened. Under what circumstances should the police intervene and how could they ensure both the safety of the person and the public?
The proposed Bill is intended to support law enforcement officers in complex scenarios, recognising that their primary responsibility lies in ensuring public safety, with considerations of accountability, danger to others and danger to self.
On the other hand, mental health professionals rightly prioritise treatment, compassion, and recovery. Finding the right balance between these perspectives is crucial.
To this end, there must be clear operational thresholds for intervention, specialised officer training, and a stronger emphasis on collaboration between police and mental health professionals.
TRAINING FOR PRACTICAL SKILLS
Risk assessment is an imperfect science, and there is ambiguity that comes with predicting dangerousness in complex situations.
The expanded powers would allow police officers to take someone into custody before any actual harm is caused if the danger is “reasonably likely to occur” and need not be “imminent”.
Without clear definitions, there's a risk of both inaction in the face of genuine threats and disproportionate response to the actual risk. Some scenarios demand immediate intervention, but one prioritising de-escalation and swift involvement of mental health professionals.
The diversity of mental health conditions and crises means that clear risk thresholds for police action still need to be appropriately applied and the risk of misuse minimised.
Certainly, it is unrealistic to expect police officers to be trained to the level of a mental health practitioner, but it is possible to equip them with the practical skills needed to navigate the nuanced realities.
Someone with panic disorder could suddenly experience a severe panic attack in public, characterised by shouting and erratic behaviour. An officer trained in active listening and de-escalation skills could engage with greater care to use non-threatening body language and a gentle tone. Acknowledging their distress and offering support can help guide the person towards the necessary help more safely.
Specialised training and deeper collaboration between law enforcement and mental health professionals are thus pivotal for a response that goes beyond the conventional model of arrest and conveyance to mental health facilities.
THE INTERFACE BETWEEN POLICE AND MENTAL HEALTH
Recognising the interface between police and mental health, various collaboration models have emerged worldwide, each with its own strengths and challenges.
Some programmes centre on a specialised police response (like in American city Memphis' Crisis Intervention Team) by providing intensive training to a subset of officers to improve de-escalation and potentially reduce the use of force. But the availability of these trained officers can limit effectiveness.
Nordic countries practice a mental health-first response using specialised “mental health ambulances” to respond, prioritising mental health professionals for lower-risk situations and minimising police involvement. While this focuses on well-being, it relies on accurate risk assessment and may face challenges in the timely availability of mental health responders.
Another model used in three Australian states emphasises collaborative response, sending unified teams of police and mental health professionals as first responders in certain mental health crises. This aims for holistic intervention, but coordination and resource allocation can be complex. In one state, the chief police officer said police officers were often sent alone as demand outstripped capacity.
In Singapore, the Institute of Mental Health (IMH) introduced the crisis response team (CRT) in 2021 as form of collaborative response. It is designed to offer real-time support to police officers, who can call a dedicated hotline to consult mental health professionals, and psychiatric nurses can then be deployed to crisis scenes if needed.
It aims to provide a more informed and potentially de-escalatory response. And while the team has focused more specifically on suicidal crises, there are plans to expand it to include other forms of behavioural health crises.
But there will always be some implementation challenges - from gaps in awareness and resourcing to institutional inertia - and the uptake of CRT could always be better from the perspective of mental health professionals, patients and their families.
Having the power to apprehend does not mean sticking to a default model of arrest and eventual conveyance to a psychiatric emergency facility.
The persistence of such an approach could potentially lead to an increase in unnecessary conveyance to IMH for those exhibiting behaviours that are merely different, not dangerous, which risks exacerbating the mental health stigma and placing additional strain on our limited mental healthcare resources.
THREE STEPS FORWARD, TWO STEPS BACK?
The new Bill has elicited concerns about potential setbacks, with some suggesting that it represents a step back for mental health advocacy. As we navigate the complexities it introduces, it's essential to consider the broader trajectory of mental health advocacy and legislation in Singapore.
The decriminalisation of suicide and the formulation of a national mental health and well-being strategy represent significant strides towards destigmatising mental health issues and promoting a more compassionate approach to mental health care. These advancements underscore the country’s commitment to understanding and addressing mental health with the sensitivity and depth it deserves.
The essence of progress in mental health advocacy is not defined by the absence of setbacks but by the ability to move forward - even if it involves taking three steps forward and two steps back. Despite the challenges the new Bill might present, there is still forward momentum.
The process of refining our approach to mental health crises requires continuous evaluation and adaptation. The new Bill simultaneously paves the way for innovative and collaborative approaches to mental health crisis management.
Mental health professionals and law enforcement officers have a responsibility to work together to ensure the best possible outcomes. A multi-stakeholder committee could give and gather feedback on operational processes, evaluate intervention strategies to inform policy adjustments. Only then can we ensure both public safety and the compassionate treatment of those in mental health crises.
What matters now is how stakeholders are engaged and collaborate so that Singapore does not detract from the strides made in mental health care.
Dr Jared Ng is Senior Consultant and Medical Director at Connections MindHealth. He was previously chief of the department of emergency and crisis care at the Institute of Mental Health.
